Use of Standardized Educational Video to Overcome Patient Fears and to Improve Colonoscopy Preparation Quality

Abstract

Introduction: High quality bowel preparation is essential for a successful outpatient colonoscopy. However, 20% of all colonoscopies in the U.S. are limited by suboptimal preparation that can lead to prolonged procedure time, adverse outcomes, and missed lesions. Anxiety regarding the bowel preparation and procedure is reported by up to 30% of patients undergoing outpatient colonoscopy. At present, the use of quality improvement with colonoscopy education video to allay patient fears and improve colonoscopy bowel preparation quality has not been well-studied. We aimed to determine if augmenting traditional patient counseling with a standardized, national GI society-vetted educational video decreases patient anxiety surrounding the colonoscopy procedure and improves bowel preparation quality. Methods: At a single center, patients referred for first time screening colonoscopy were randomized to receive standard pre-procedure counseling per clinic protocol followed by a national GI society-vetted 10 minute video or usual counseling alone. Health literacy was determined using the Rapid Estimate of Adult Literacy in Medicine (REALM) score. Patient-reported anxiety levels on a 1-5 Likert scale were measured on enrollment, after counseling, and immediately prior to the procedure. The endoscopist, blinded to the education method of the patient documented the Boston Bowel Preparation Score following completion of the colonoscopy. Results: 71 patients completed the study (mean age: 52.6 years; 63% male). 29 patients were randomized to the video intervention group (VG) and 42 to the usual counseling group (UC). Mean anxiety scores prior to counseling, after counseling, and on the day of the procedure were similar between the two groups (2.8, 2.4, and 2.4 respectively within the VG and 2.3, 2.0, 2.4 in the UC). Anxiety levels improved for both groups after education and remained lower for the education video group prior to the colonoscopy procedure but the difference was not statically significant. Average Boston Bowel Prep Scores were also similar between groups (6.9 in the VG and 7.2 in the UC). Conclusion: In patients undergoing their first colonoscopy, the use of a second teaching modality for patient counseling with a standardized educational video did not provide an additional benefit in decreasing anxiety or improving the quality of bowel preparation.